Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Cash flows from operating activities:
Net income	$ 4,035	$ 14,206
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	10,308	8,953
Amortization of premiums, discounts and issuance costs	200	393
Stock-based compensation expense	3,067	3,009
Deferred income taxes	686	2,008
Other	(1,265)	(391)
Changes in assets and liabilities:
Accounts receivable	(9,936)	21,345
Prepaid expenses and other current assets	3,756	(4,470)
Other long-term assets	5,900	952
Accounts payable and accrued expenses	(141,463)	(150,125)
Income taxes payable	3,017	5,299
Long-term professional liabilities	4,082	2,378
Other liabilities	(5,011)	(4,201)
Net cash used in operating activities - continuing operations	(122,624)	(100,644)
Net cash used in operating activities - discontinued operations	(2,602)	(273)
Net cash used in operating activities	(125,226)	(100,917)
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(8,167)	(1,667)
Purchases of investments	(16,896)	(9,549)
Proceeds from maturities or sales of investments	14,155	6,865
Purchases of property and equipment	(5,330)	(6,999)
Net cash used in investing activities	(16,238)	(11,350)
Cash flows from financing activities:
Borrowings on line of credit	170,500	216,000
Payments on line of credit	(90,500)	(106,000)
Payments on term loan	(3,125)	(3,125)
Payment on finance lease obligation	(690)	(703)
Proceeds from issuance of common stock	860	1,095
Repurchases of common stock	(887)	(775)
Other	46	2,075
Net cash provided by financing activities	76,204	108,567
Net decrease in cash and cash equivalents	(65,260)	(3,700)
Cash and cash equivalents at beginning of period	73,258	9,824
Cash and cash equivalents at end of period	$ 7,998	$ 6,124